Employers that have access to key data on their healthcare spending and costs are more likely to take steps to address affordability and pharmacy benefit transparency, a new survey shows.
The National Alliance of Healthcare Purchaser Coalitions polled 408 employers, ranging from small companies to jumbo firms, for its annual Pulse of the Purchaser survey. It found that these firms cited three top sources of affordability barriers: drug prices (77%), high-cost claims (75%) and hospital prices (68%).
The companies with the data to act on these challenges were more likely to have implemented high-value purchasing strategies, averaging 11.9 versus 7.9 for those with more limited access to data. Approaches deployed include direct contracting, centers of excellence and site-of-care redirection.
Shawn Gremminger, president and CEO of the Alliance, told Fierce Healthcare in an interview that employers often have to rely on plans to provide the data they need, and that insurance carriers can frame that data as they prefer.
When employers have open access to this information, they can use the data in ways that suits them. For example, there may be a high-risk population concentrated in a certain plan that these employers could better manage, or employees have varying needs depending on where they live, Gremminger said.
That transparency also makes it easier to steer patients to sites of care that are the best value, with lower cost and quality outcomes, he said.
"If you have a broad plan design, you can engage in things where you would say, all right, we're going to have a tiered cost sharing incentive to try to drive people to higher value, lower cost, higher quality sites of care," he said.
"The other direction that employers can go in is they can just have narrower networks, which I know is somewhat controversial, but I think can also be really impactful," Gremminger said.
Securing greater transparency and a deeper look into pharmacy spend is also a key priority, the survey found, with 87.6% rating PBM reform as either very or somewhat helpful. As pharmacy costs mount, nearly half (43%) of the employers surveyed said they were considering switching to a new PBM within the next three years.
The share of surveyed employers contracted by one of the industry's Big Three companies—CVS Health's Caremark, Cigna's Express Scripts and UnitedHealth Group's Optum Rx—declined from 63.4% in 2025 to 54.3% for 2026. The largest interest in switching was found among smaller employers with 1,000 or fewer employees, with 55.7% considering a change.
Jumbo employers, or those with more than 10,000 employees, are slower to change, but are also considering new models, per the survey.
Gremminger said there have been multiple years in which the survey has shown employers considering a change, and this year's poll shows them putting those plans into action. Larger firms, he said, aren't acting as quickly as they still have questions about whether an alternative PBM can manage a group of their size.
"One of the things that we've been very focused on, and I think employers are getting their minds around, is moving away from thinking about rebate maximization, and moving to a lowest net cost paradigm," Gremminger said.
Employers also increasingly view hospital price transparency as a policy priority, according to the study. Most (84.6%) said that hospital price transparency is a helpful reform, while 82.6% said the same about hospital rate regulations. In addition, 72.2% said greater enforcement of hospital antitrust as helpful.
Exploring direct contracting is another way they're looking to get their arms around hospital costs, Gremminger said. Transparency feeds back into that, as they can come to the table with a provider fully informed, he said.
"That information empowers the employer to say, 'I feel more confident in doing a direct contract because I know where I am, I know where my starting point is, and I know where I want to be,'" he said.